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HomeMy WebLinkAbout4476DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84.19 -1 -5 BOX 34 04476 61 . i T r �r NJ . 04476 lit CONSTRUCTION Located at Subdivision PUTNAM COUNTY DEPARTMENT OF HEALTH ENGINEER TO PROVIDE PERMIT # ON CERT F I C E OF POMP.I ANA Division of Environmental Health Services, Carmel, N. Y. 10512 PERMIT .SF-IAIAGE, DISPOSAL SYSTEM 14)/�� I own or Village fed, 1 — Tax Map Biook .lut. _ ....... - Subd. Lot a Owner /Address �" iw • _ Lot Area Building Type Number of Bedrooms Design Flow G /P /D ____L__ -- Separate Sewerage System to consist Of Gal. Septic Tank To be constructed by Renewal ❑ Revision _❑ Date Of Previous Approval Fill Section Only ❑ P.C. H. Notification Requiredy.� and U �� .�i7 f� i✓1G° �P1�1?�sf Address Water Supply: Public Supply From L ---4-'Private Supply to be drilled by Address Other Requirements eeeaoacenoonn yo E @ the separate sewage disposal system 1 represent that I am wholly and completely responsible for the design and location of the propot�(5 ►, 11 r s an regulations O e u nam above described will be constructed as shown on the approved amendment there to and in actor A (+ "pew t� t r o the Commissioner of Healthwill County Department of Health, and that on completion thereof a "Certificate of Constructs C 4fb irs orb s b°the builtler, that said builder will be submitted to the Department, and a written guarantee will be furnished the owner, hi suds, ears i ly following the date of the isw- place in good operating condition any part of said sewage disposal system during the p �d wo (. eto 2 thhaa the drilled well described above ante of the approval of the Certificate of. Construction Compliance of the original syst or' ' say r b�P will be located as shown on the approved plan and that said well will be installed in accordan wh the ' s, r anal regula ons of the Putnam County Department of Health. P.E. Date ign d ee 4 ..-- r Address he building has been undertaken and is APPROVED FOR CONSTRUCTION: This proval expires one year from the date issued u ss c revocable for cause or may be amended o modified when idered necessary by the Co issioner f Health. Any Chan or n of construction require4new rmit Appr r disposal of dome is ita sew a or priv to wata p Y Title Date BY Rev. 6/85 ._ _:AA IT. - " All � PUTNAM COUNTY DEPARTM ENT ••) OF HEALTH ENGINEER MUST Division of Environmental Health 5ervroes, Carmel, N. Y. 10512 pERMITE# "CMIF1C " OF CONSTRUCTIONV- COMPLIANCE -FOR SEWAGE 'DISPOSAL SYSTEM I)r-> "I e Town or Village Located at d ✓? �L/ ,LY ,J� Tax Map Block Owner r �i / 13 ref'./ %l4/• Cam/ Formerly Tax Map Lot # ,=J ( 1- Subd. Lot If Separate Sewerage System built by & kv-tn t' P .cr /fir Address Consisting of Gal. Septic Tank and Other r �® equirements Water Supply: Public Supply From ✓�� / ✓1 i`r+ 0✓Jr Private Supply Drilled By Address Building Type No, of Bedrooms 7 Date Permit issued Has Erosion Control Been Completed? Has garbage grinder been installed? I certify that the system(s) as listed serving the above premises were constructed essentially as shown on the plans of the completed work ( copies of which are attached), and in accordance with the standards, rules and regulations, in accordance with the Putnam County Department Of filed plan, and the permit issued by the Healltth. %l G of E Date Cer ttf led by =e . P.E. R.A. Address License No. Any person occupying premises served by the bove system(s) shall pro tly s h°ecti conditions resulting from such usage. Approval of the se a ass 'to secure the correction of any unsanitary available and t e a prvate sewer ge sy nr al s and 'loon as a public sanitary sewer becomes pprovsi f the private water supply shall become null nd a ter subJect to mo ificati n di change when, in the Judgment of the Com Issi a becomes available. : `Such approvals are i ► N cation or change is, necessary. Date By a Title —�� PUTNAM COUNT( DEPARTMENT OF HEALTH DIVISION OF ENVIROi�TAL HEALTH SERVICES ... .,_, I er or Purchaser of Building Building Constructe/d. by Location -'Street, Municipality Building Type Section Block Subdivision Name Subdivision Lot # GUARANTEE OF SUBSURFACE SEMM DISPOSAL SYSTEM I represent that I am-wholly and completely responsible for the location, workmanship, 'material ; construction and drainage of the sewage disposal system serving the 'above described property, and that it has been constructed as shown on the approved plan or'approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the w "Certificate.-of Construction .Compliance" for the sewage disposal system, or any repairs miade 6y me to'.such, system, except= where the failure-to opezacte pxoperly °Rzs caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environinental Health Services of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent. act of the occupant of the building utilizing the system. Dated this day of 19 (F'd 1 ,Abn&al Contractor (Owner) - Signature (',yuCX�c � y ' u rporation Name (if Cog.) 6e P, 3 Rr_� rev. 9/85 mk Signature Title rat: o_,Name (Y �Cor . ) Add ess T� s FIM-CF-T �* YI• a �� • � , .- ,� ♦/ �� Ya •� a INS FIEND +IRfiSPDLT�ON RED . DATE: INSP. BY: (Name of.Owner) (Street Location) INITIAL SITE INSPECTION YES NO CPI'S Wetlands on/or proximate to property .............. Property lines or corners found ................... Can estimate house location ........................ Will driveway need cut .:....................:..... Must trees be removed - note these................ Deep holes representative of entire SDS area...... Additional deep holes needed............ w Sufficient SDS area available considering driveway cut, house location, separation distances,etc... Adjacent wells/ septics ......................... .. D.H. 1 Lot Depth to G.W. Depth to rock Soil Descriptii 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. D.H. 2 Lot Depth to G.W. Depth to rock Soil Descri tia 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. D.H. - Deep Hole G.W. - Groundwater D.H. 3 Lot Depth to G.W. Depth to rock Soil 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. DATE: FINAL SITE INSPECTION INSP . BY • YES NO COMMENTS House SSDS located per approved plan ............. Length of trench measured 4GY� Width of trench average Slope of tile line and trench acceptable......... Roan allowed for expansion trenches.. ` ............ Over 100 ft. from watercourse .................... Natural soil not stripped or SDS area unnecessarly graded ............................. 10 ft. maintained from property line and 20 ft. from house........... ���c ......... �% Distance well to SSDS (ft.).. ... mil/......... Number of bedrooms checks ........................ Stones, brush, stumps, rubble, etc., greater than 15 ft. from nearest trench................ 15 ft. of peripheral soil horizontally from trench ..... ............................... Boxes properly set .............................•• Could surface runoff from driveway, roads, ground surface, etc., channel near SDS area..., Does lot drainage appear OK in area of SDS.......' is Std, Rem'rl<3 0 Dill LRJ71 ITS Yes- DIo = .Conmonts Property lines or corners found . . . . . Can estimate house location . . . . . . . . �Q ARP L6CAr10N . P )use plans O.K. Am _ % Q :sign data sheet ✓ s ,res presoaked? + �- in. 30" perc test depth - �nst. results for 3 runs i NON FW W Hole lots 0. K. � 1 )rporate Affidavit for other than individual Additional doep holes needed. . . . . . , p . �.i ithorization for engineer I Sufficient SITS area available considering ,tter from Water Supply if applicable ' I ! variance requested -such noted on plans & apps.: -_ r E ' Fvrj SbN E 161JRT%1RE � --"L 0"3 P�q NAILS I, J. Depth: # - - -- - DepTM I PRea- SHOl.:n ( Cy) NOr--: PIAM r0 BF VROJ,4ED dst}ng contours shown (show new contours) a .opes for driveway cuts, etc. shoran Water elevation:. _ Lter service line location Loting drain, etc. location + ✓ I )p slope, bottom slope of fill I + :rcolation tests and deep test pit location I a 1= :Dtic tank size and conformance to std. ✓ + I 13. R. house minimum ! Luse setback shown .stribution box ft,. belcnr frost ✓ i .1 water within ;�t. of..PL shown -• .: .-'.L-,Ch SNG 12" j)ZOVE 6eapc G ` rJ� Wc; LV_ . ✓f 11.... Plan and profile SDS .. ...� ........ ....... ...... ; f All other wells and SDS closer 2001 + I shown or reference made _..._ Property boundaries (metes and bounds- clearly shown) Width of trench average Slope of tile line and tr— encFi.acceptable . LEGRL sL,aolus+°,.� i J � -� �fISTINCa Appeov4L , _.. REALTY vV�DNIS10rJ Z. _•. Natural soil not-.stripped or SDS area WerLAAJb tD MI S .. i'ARPMON DISTANCFS SPECIFIED ON PL4N ' 1 to P.L. gy ', to foundation wa lls to Nearest well ! w +c Y to stream, march, lake, etc. incl.expans on — ' to Curtain drain R _ ' to water line (pits -20 ' to storm drain ! '*to large trees ' from foundation to septic tan: ' to pipe from leader drain &,fooUne, drain. i To .CRTr-* 6flSILJ WELL TD VL D' . se PT�IGp_.T. Rr.31L To. .o EL.L_ .. . s • 40' 2Z than 15 ft. from nearest trench . . . . . . lI ' '1 FIPT,D CHPCK LIST. Insp.by: I INITIAL SITP INSPFCTIOi; T ) Yes- DIo = .Conmonts Property lines or corners found . . . . . Can estimate house location . . . . . . . . P Am _ O Will. driveway need cut . . . . . Must trees be removed -hote these NON FW W Is deep hole representative of entire SD:, area Additional doep holes needed. . . . . . , p . Sufficient SITS area available considering driveway cut, house location, separation distances, etc. 41a, IAELL�SEPTICS - -� -_ •PVv ;Ci' , ✓ . DEPP HOLE DATA ail. -� �'b' Depth: # - - -- Water elevation:. _ Rock elevation: • Soils degcr.lr_)tion- ' te: _ FINAL SITE I'SPECTIOD? IIns . by: 'c House located where shoran on approved plan --- — SDS located where approved . . , . . , . _..._ 1k,ng'th of trench moasured Width of trench average Slope of tile line and tr— encFi.acceptable . Room allowed for expansion trenches . . . . . Over'55e-ft. from swamp,vatercourse _.. _•. Natural soil not-.stripped or SDS area unnecessarily graded . . . . . 10 Ft. rfaintained from prop.line and 20 £t. from house . . . . Separation of trench from house, well etc.- follows plan . – , - - -- . . . . - • - Nwnber of bedrooms checks . . . . . Stones, brush, •stumps, rubble, etc: greater than 15 ft. from nearest trench . . . . . . '+ 15 I't. of peripheral soil horizontally from trench �- Junction boxes properly set Coiild surface run off from driveway, roads, ground surface, etc. channel near SDS .. area. . . . . . . Does lot dra ina ;e arn�evr 0. K. �i.n area of SD.S a FINAL GRADING OF SITE ACCEPTAME �S� L J PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services _ ...... _' AF•F`IDAVi l - COkP0ECt1TE"- OWYER�= Af�ALT�,ATION .._� .+ :>~:q , °.. '� <�.�- - FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT TO: Commissioner of Health In the matter of application for: Ve yk_ I , e3- lie Grit- j represent that I am an officer or employee of the corporation and am authorized o- jj to act for ,.) r-0 J_ , "ie 1. �y'..S 6G",� ,`v✓l. G-,, V_ "-,) - (Name of Corporation) having offices at Whose officers are: President: tf�i Vice - President: - Secretary: Treasurer: (Name and Address (Name and Address) (Name and'-Addiess (Name and Address) and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating thereto. Sworn to before me this 4.2 day Signed:`"' of 19 it S Title: a a b- 1 Notary Public Felicia G. yilinogradoff (Votary Public State of New York # 4802507 Qualified in Putnam r -:. t,- v Term Expires MF-rei ;o i 104. Corporate Seal 8/84 J i Y PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH.SERVICES ,Y Date Re:. Property of,n Located at 414/41VSection 1'7V Block Lot 3 G J _ h Subdivision of Subdv. Lot #LS Filed Map # Date Gentlemen: This letter is to authorizes -C,� /1 ,� // ✓�� a duly licensed professional engineer � or registered architect (Indicate to apply for a Construction Permit for a. separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and. to. supery .se_tie.Constructi,on.,of, said. system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours, ` o � Signed Owner of Property Countersi j Ilk. a P.E., Rsi1s# Address Ire Address %2 y> Telephone Town Telephone ` ' ; i '~L, "; } )DEPT. OF PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _.OFFICE BUILDING.,- CARMEL, N: —Y 105d2-- DESIGN DATA /SHEET-SEPARATE SEWAGE DISPOSAL ,SYSTEM FILE /NO. Owner �,/�f�:��%�'- Cola Address Located at (Street / /�+la^� �i"c�k Sec.JZ,­e, Block Lot Indicate nearest cross street) Muni Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS 5 5 1 3 t DEP-r. OF T ` Notes: 1) T6 is to be repeated at same depth until approximatelyy equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 12) Depth measurements to be made from top of hole. Role Number CLOCK TIME' PERCOLATION PERCOLATION Eun Elapse No. Time Start -Stop Min. Depth to Water From Ground Surface Start Stop Inches Inches Water LFveI in Inches Drop in Inches Soil Rate Min. /in drop 5 5 1 3 t DEP-r. OF T ` Notes: 1) T6 is to be repeated at same depth until approximatelyy equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 12) Depth measurements to be made from top of hole. DEPTH G.L. 61' 1211 1811 2411 3011 36" 42tr. 4811 5411 6011 66t1 V11 78811 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION..OE_SOILS ENCOUNTERED IN TEST HOLES HOLE NO. r HOLE NO. -- HOLE N0: yy 1 9 84" INDICATE DIET, AT WHICH GROUND WATER .IS ENCOUNTERED -� IN DIL WATER LEVEL RISES.'AFTER. EE-ING,t ENCOUNTERED; . TESTS MADE BY i) i �✓� Date 3/- t::_ DESIGN Soil Rate Used Nin/1 "Drop: S. D. Usable Area Provided No. of Bedrooms Septic Tank Capacity Gals. Type��� Absorption Area L.F. x24" width trench. Other name fir,, bi.gnature Addre s s F SEAL 1 `T •p. �S THIS SPACE FOR DEPARTMENT ONLY: K S. , Soil Rate Approved Sq. Ft /Gal. Checked by Date -Thi:3 is to CLT— If), Y t -nnt.-trixted. as p.� tar -nd t?Lat the rys z .-zs t ---'ad ovez w a s r!-nn u r. ' 4 T s and r e C u..-, at o: 0 -f t 7�,: j;-, 1 y D e. D a r t-, e n t 0 f Health and the ',Iew `or-k ,_" ate n t of Hc lalth. 'Fw e. �2el zo F /1-11119 C / 20 -38 m N N 'Fw e. �2el zo F /1-11119 C / 20 -38 m 1 41 Q� Lk� '44 NA RE E /V P 120(vp 11V,7 :5 ef,4'- 4,7� Putna--, Gc,unty Department of Heajt". Division of Enviro-mental P.e,-I-lh Service@ App Ved asnctcr for confo.;,,.a:-.ce wl'--a p icab-, e T.-1 -73 I�e,,-ulati Orl.- ol tr Pu am ount- i -alt'.' Sure Title Date P4 2 23 ----------- 27 37 37 7o 120(vp 11V,7 :5 ef,4'- 4,7� Putna--, Gc,unty Department of Heajt". Division of Enviro-mental P.e,-I-lh Service@ App Ved asnctcr for confo.;,,.a:-.ce wl'--a p icab-, e T.-1 -73 I�e,,-ulati Orl.- ol tr Pu am ount- i -alt'.' Sure Title Date